DOLS and Liberty Protection safeguards update Neil Hunt MCA DOLS Manager Invicta House, Maidstone, Kent

DOLS – where are we now? Cheshire West Supreme Court judgement (2014) set out a definition of qualifying criteria for dols Is the person “free to leave” And are they subject to continuous supervision and control?

Numbers of referrals went up ten to twenty fold overnight. The floodgates opened!!! Numbers of referrals went up ten to twenty fold overnight.

Current Picture March 2019 The Kent MCA DOLS Service received 5,204 applications for Standard Authorisation from 1/4/18 to 14/03/19. Senior staff continue to scrutinise every application on receipt and referrals are prioritised using the ADASS screening tool. Prioritised referrals amount to approximately 35-40% of the total applications received. We issued 2,258 DOLS outcomes between 1/4/18- 14/03/19 , including 2141 authorisations granted and 115 authorisations not granted.

How can you help us to prioritise referrals? - We use the ADASS tool when triage-ing new referrals, so it really helps us if we receive good quality referrals:- It is really important to know if the person is objecting to any of their care? b) Have they recently been under section of the MHA? c)are they resistive to care? d) Is the person subject to a high level of restraint? e) Are they subject to 1 to 1 care? f) Is sedation or medication regularly used to control behaviour? g)Are there objections from family or friends; are family restricted from visiting? h)Are they trying to leave? Regularly asking to leave? i) Is it a new placement? j) Do you think that it is likely to result in a court challenge?

Project DOLS 2018-20 Additional funding has been allocated for processing historic non-priority DOLS applications and has been spread over a 2-year period from April 2018. The aim has been to commission a service for the completion of non-priority DOLS Best Interests Assessments, whilst leveraging the existing contract for the completion of DOLS Mental Health Assessments. This new service referred to as “Project DOLS” started in July 2018. A separate Project DOLS team has been set up in KCC to manage the provision of referrals and a new provider has been commissioned to work with Project DOLS to process the backlog of historic DOLS applications. The new provider is ICS Assessment Service,(ICS) they will be carrying out all assessment work and then KCC as supervisory body will issue the authorisation outcomes. The Project DOLS work is separate from the priority workstream), so that the backlog work should not affect the efficiency of the priority work. Since 1st October 2018, Project DOLS has reviewed 998 applications, they have closed 316 granted 639 authorisations, and not granted 43.

There are currently 21 cases of people who are challenging their dols ( under section 21a) in the court of protection. .

Liberty Protection Safeguards is coming! Mental Capacity Act Amendment Bill is being “ping ponged” back between the lords and commons

Summary of Key changes Deprivation of Liberty Safeguards To From Deprivation of Liberty Safeguards   To Liberty Protection Safeguards 6 assessments carried out by Best Interests Assessors and Section 12 doctor (psychiatrist) . If it is clear that some one is objecting to their care then an AMCAP (approved mental capacity professional) must be consulted. Definition of a DOLS relies on Cheshire West Supreme Court Judgement – the “acid test” (2014). New definition of a DOLS is being developed and debated between Commons and Lords Apply in hospitals and care homes . Apply in hospitals, care homes and community settings. Based on the person’s best interests and on whether the arrangements are necessary and proportionate relative to the likelihood and severity of harm to that person. Based on what is ‘necessary and proportionate’ but without definition linking this to the person’s best interests. This means that there is no absolute requirement to prioritise the person’s best interests.

Key changes DOLS vs LPS From Deprivation of Liberty Safeguards To   To Liberty Protection Safeguards Key changes DOLS vs LPS   Supervisory bodies are local authorities and, for hospitals in Wales, Welsh health boards. In social care, local authorities as responsible bodies will authorise and monitor the LPS in care homes and community settings except when funded by Continuing Health Care. NHS trusts and Clinical Commissioning groups will be responsible bodies. Six assessments arranged and commissioned by the local authority carried out by specialist professionally qualified staff. In care homes, three assessments are arranged and commissioned, , can be arranged but not carried out by the registered manager, send to responsible body (LA or CCG) for a pre-authorisation review, notify the LA of any objection. Local authority drafts and grants a setting-specific authorisation of arrangements giving rise to a deprivation of liberty. Authorisations apply across any settings (including transport) for arrangements amounting to deprivation of liberty: in the case of care homes, the LA signs an authorisation which could have been commissioned by the care home manager.

Current Concerns/ Implications There were significant concerns about the conflict of interest associated with placing LPS assessment responsibilities on registered managers. These concerns have resulted in amendments which suggest that Responsible bodies can decide if they allow care homes to complete their pre authorisation assessments. Also following amendments, no staff employed by care homes can carry out these assessments! Scheme extended to 16 and 17 year olds Requirement for assessments to be carried out by people with sufficient knowledge and experience Person at risk of deprivation must be consulted at every stage Change to role of AMCP- extended Care home managers not responsible for notifying responsible body whether an IMCA should be appointed WAITING FOR A CODE OF PRACTICE !!!

What happens next ? ? The Mental Capacity Amendment Bill is at the “ping pong” stage between the House of Lords and the House of Commons. Earliest to be in law by April 2019 To get Royal Assent by May 2019? A lot of store placed on a detailed Code of Practice Work has started on the Code of Practice, interested bodies and agencies involved in drafting the code. Decisions to be made about relevant training Accompanying legislation to be brought in e.g. for registration and profession of AMCAPS Earliest to be enacted possibly April 2020

Thank you for listening I hope you aren’t feeling Petra- fied!!!